Incorporating drug shops in the management of sexually transmitted diseases: suggestions from a study in Uganda

Abstract

We have previously reported on the poor management of sexually transmitted diseases (STDs) in the formal and informal private-for-profit sector in Uganda, represented by clinics and drug shops, respectively. 1 Drug shops appeared to be consulted particularly by STD patients of the lower socioeconomic strata. In order to formulate strategies that may lead to improved STD management practices by drug shop staff, we conducted a study of their advice and dispensing practices. 2 The study was conducted between November 1998 and February 1999 in tandem with an evaluation of a pilot scheme for social marketing pre-packaged treatment for men with urethral discharge in drug shops, private clinics and pharmacies. 3 Drug shops made up a substantial percentage of outlets for the social marketing study that was conducted in six sites in Uganda: two divisions of Kampala and four rural districts (Jinja, Luweero, Mbarara and Masaka). Two trained interviewers were already operating at each site and were familiar with most of the drug shop staff.The following research methods were employed:(1) One hundred and twenty-seven semi-structured interviews with drug shop staff (63 owners and 64 dispensers). Questions concerned qualifications of the dispenser, duration of employment and type of remuneration.(2) One hundred and eight simulated client visits by male interviewers who pretended to suffer from urethral discharge, requested 40 ampicillin capsules and queried the appropriateness of the antibiotic for their symptoms.(3) Participant observation whereby a median of 12 h (range 10-21 h) was spent in 26 drug shops, with a total observation time of 332 h during which 1291 customer-dispenser interactions were observed. In addition, the presence of expired drugs was assessed. (4) Seven focus group discussions (FGDs) with a total of 62 drug shop owners and dispensers.Of 127 drug shops, 90% were owned by holders of a degree in a medical subject as required by the National Drug Authority, 4 but 66% employed a dispenser, of whom 80% had a degree in a discipline related to medicine and 27% were paid a sales commission. The drug shop staff interviewed had worked a median of 20 months (range 1-120) in the drug shop, a median of 24 months for owners and 12 months for dispensers. Half the drug shops had an expiry date on all antibiotics, 42% on some and 8% on none; 46% sold expired drugs. Table 1 indicates the characteristics of the customers and their reasons for visiting a drug shop. Men tended to buy antibiotics, while women more often sought advice. The retail pharmacy behaviour for three areas of consultation is summarized in Table 2. Of the 106 customers disclosing the intended use of their antibiotics, a fifth (21) mentioned the treatment of an STD.In all, 18% of simulated clients were queried when they requested ampicillin. The need to treat their sexual partner and to use a condom or abstain from sex during treatment was mentioned to only 12% of the clients. Injections, which tend to be more lucrative than the sale of tablets, were propo...

STI management in Tanzanian private drugstores: practices and roles of drug sellers

“…An increased role for pharmacists and drug sellers in STI management has also been suggested by others, and in Ghana licensed pharmacists are recognised as the preferred healthcare provider for STI patients 8 10 25 26. In Tanzania, upgraded drugstores, so called ADDOs (accredited drug dispensing outlets), licensed to provide a selected range of POM and OTC, have been tried out through a programme that is anticipated to be scaled up in the whole country 27 28.…”

The availability of six tracer medicines in private medicine outlets in Uganda

“…Pharmacies predominantly exist in urban areas, while drug shops are distributed evenly in rural areas [15]. Qualitative studies in Uganda have highlighted problems associated with drug outlets including; inadequate information given to patients, irrational drug sales, or the inappropriate use of medicines and illegal sale of prescription drugs [15][16][17][18][19].…”